Communicable Disease Updates for

Local Health Departments Q4 2023

The 2024 IDPH Infectious Disease Conference will be held at Illinois State University in Bloomington-Normal on April 23-24. Sessions will focus on communicable disease surveillance and outbreak investigations, immunizations and infectious control. See the conference website for more details.

New Process to Request IDPH Lab Testing Approval

for Select Diseases

Testing at the IDPH Laboratories for select communicable diseases requires notification and approval by IDPH Communicable Disease (CD) staff, including testing for:

diphtheria
measles
mumps
rubella
Streptococcus pneumoniae
influenza
unknown respiratory disease
hepatitis A
invasive Group A Streptococcus
other conditions (when indicated by IDPH staff)

A new process has been implemented for local health departments to request approval using a REDCap form. Instructions on submitting a request can be found on the Lab Testing Authorization for Communicable Disease portal A-Z page. Prior to completing the online form, local health department staff should consult with IDPH CD staff (CD Program Staff by Disease) to discuss the need for testing and if submitting a specimen to the IDPH lab is appropriate.

Resources for Food Establishment Outbreaks

A key part of an outbreak investigation in a food establishment is the environmental investigation. The IDPH CD Foodborne team has been working with the IDPH Environmental Health team to develop pathogen specific resources to help guide the steps of that investigation in the establishment. So far the teams have developed two checklists for responding to norovirus and Salmonella outbreaks with additional checklists to come soon. The checklists focus on employee health, collecting additional information, environmental assessment, cleaning/sanitizing and other control measures, and communication. Local health departments can check out the new resources on the Outbreak Toolkit portal A-Z page under section G. Initiate an Environmental Investigation.

How to Prepare for a Measles Case

In October 2023, the first measles case in Illinois since 2019 was identified in Cook County. Subsequently, four additional epi-linked cases were identified over the next several weeks with a total of five cases ultimately identified as part of the outbreak. This situation highlights the importance of ensuring patients are receiving their vaccinations according to the recommended schedule and the need for public health partners to be prepared for a measles situation. Local health departments (LHD) should ensure they have plans in place in the event a measles case is reported in their jurisdiction and IDPH has an abundance of resources on the Measles portal A-Z page.

The following quick steps (while not all-encompassing) will help you prepare for a similar situation and provide guidance on what to do in the very early stages when a suspect measles case is reported:

Before you have a case, read through the measles portal page, including thoroughly reading and reviewing the measles investigation guidance document.
Continuously educate healthcare providers in your jurisdiction to ensure they know how to manage suspect measles cases seeking care, including reporting requirements. Have plans for after-hours reporting of cases and facilities should have the LHD after-hours contact number.
When a suspect case is reported, the LHD should immediately report all suspect measles cases to IDPH CD via phone or email, ensuring you speak to someone to consult on the situation.
LHDs should complete the Measles Case Investigation Form (found on the measles portal page) and share the completed form as soon as possible with IDPH VPD staff so public health testing decisions can be made. Make sure to obtain patient history with symptoms, travel or exposure information, vaccination status, and other important details to determine the likelihood of measles.
If the patient is currently in a healthcare facility (HCF), make sure they are in airborne isolation. Recommend isolation precautions until four days after rash onset day (with the rash onset day being day zero). The HCF should be reminded to notify the LHD when a patient is discharged with measles so additional control measures can be recommended.
If testing at the state lab is indicated, enter the information into the REDCap authorization project and provide the authorization number along with storage and shipping instructions to the shipping laboratory. Specimens must be stored and shipped appropriately with overnight delivery to ensure appropriate temperatures are maintained.
While waiting on test results for the case, the LHD should conduct a contact investigation to identify and list all places the patient went while potentially infectious (the four days before rash onset until the four days after), while not excluding any places visited.
Close contacts should obtain their vaccination records to determine immune status. Those determined to be susceptible should receive post exposure prophylaxis as soon as possible (MMR within 72 hours and IG for specific high-risk contacts within 6 days).
Determine if the case attends any high-risk settings such as daycare or school.
If the case is confirmed, IDPH will assist the LHD with setting up daily symptom monitoring in REDCap, schedule regular check-ins with the LHD to provide support, consult regarding any additional suspect cases reported, and will assist throughout the entire process.

Please be aware this is not an all-inclusive list of everything to do after a suspect measles case is reported. However, we hope that these tips will help LHDs better prepare for what to do in those situations. If you have any questions, please reach out to the VPD team, Heather Reid and/or Jodi Morgan, who can assist.

Check out the new Seasonal Respiratory Illness Dashboard

Think, Test, Treat and STOP Pertussis

Respiratory season is officially here! At the onset of the COVID pandemic, there was a dramatic decrease in transmission of many typical respiratory viruses and bacteria. Over the last couple of years, there has been a return to more typical patterns of flu, RSV, and other respiratory illnesses including pertussis. The number of pertussis cases reported in Illinois each year varies, with significant peaks every few years and frequent outbreaks. In 2019 there were just over 900 cases of pertussis reported in Illinois, with decreases in reported cases during the COVID-19 pandemic. In 2023 there have been just over 500 cases of pertussis reported to date.

There are special precautions that need to be followed when testing for pertussis to avoid contamination and false positives. False positives lead to unnecessary antibiotics, time away from school, and missed work for caregivers.

See the Think, Test, Treat and STOP Pertussis resource on the Pertussis A-Z covering:

When to THINK of pertussis,
How to TEST for pertussis and avoid contamination of clinical specimens with Pertussis DNA,
How to TREAT and report suspected and confirmed cases, and
STOP transmission

2023 Case and Outbreak Closure

It's that time of year when we start to wrap-up and review our previous year's data. LHDs are asked to finalize and submit to IDPH all 2023 Communicable Disease cases in I-NEDSS by May 17, 2024. Outbreaks that are considered over should also be submitted to IDPH in ORS by May 17th. Reach out if you have any questions about closing cases.

LHD After-Hours Contacts

Local health departments are reminded to routinely communicate to their reporters how to reach their department during after-hours and holidays. For urgent matters directly contacting the local health department is the quickest way for a clinician to get an answer.

Meet the New IDPH CD Staff

Tamara Batiest joins the IDPH Communicable Disease (CD) staff as an Executive 2. Tamara previously worked in the Agency Performance Measurement Management Program at IDPH where she oversaw agency compliance with performance management accreditation initiatives including compliance with Public Health Accreditation (PHAB) requirements. She will be assisting with ELC Grants management including tracking, monitoring, and reporting requirements for ELC awards.